The Effect of Foot Rehabilitation Protocol in Adults With Congenital Deformity of Foot: An Analytical Case Series.

Congenital deformities of the foot significantly challenge the mobility and quality of life of affected individuals. While surgical interventions are common, rehabilitation protocols tailored to address the specific needs of adults with congenital foot deformities are less explored. This case series aims to evaluate the effectiveness of a specialized foot rehabilitation protocol in improving functional outcomes and quality of life in adults with congenital foot deformities. A series of cases involving adults diagnosed with congenital foot deformities were enrolled in a structured rehabilitation program. The protocol incorporated a combination of therapeutic exercises, manual therapy, gait training, and orthotic management tailored to individual needs. Outcome measures included functional assessments, gait analysis, pain levels, and patient-reported outcomes at baseline, midpoint, and endpoint of the rehabilitation program. Preliminary findings from the case series indicate significant improvements in various outcome measures following the foot rehabilitation protocol. Participants demonstrated enhanced gait parameters, reduced pain levels, increased range of motion, and improved functional capacity. Moreover, subjective assessments revealed enhanced satisfaction and perceived improvements in quality of life among participants. The findings suggest that a tailored foot rehabilitation protocol can be beneficial in improving functional outcomes and quality of life in adults with congenital foot deformities. This underscores the importance of integrating comprehensive rehabilitation strategies alongside surgical interventions to optimize long-term outcomes and enhance the overall well-being of individuals with congenital foot deformities. Further research with larger sample sizes and controlled study designs is warranted to validate these findings and establish evidence-based rehabilitation guidelines for this population.

Impact of static foot disorders on the conservative treatment success in chronic venous disease patients without wounds.

OBJECTIVE: Chronic venous disease (CVD) and static foot disorders (SFDs) are prevalent conditions that commonly cause lower extremity pain. These conditions share common factors such as age and weight in their etiology. This study aimed to investigate the impact of SFDs on the treatment response of patients undergoing conservative treatment for CVD without wounds. MATERIALS AND METHODS: A retrospective evaluation was conducted on 328 patients (60 males, 268 females) with CVD. Parameters including age, gender, affected side, body mass index, Visual Analog Scale (VAS), Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, and revised Venous Clinical Severity Score (rVCSS) were considered for evaluation. Radiological measurements of calcaneal pitch angle (CPA) were analyzed as a determinant of SFDs. RESULTS: VAS and rVCSS of the patients were evaluated before and after conservative treatment of CVD without concomitant treatment of SFDs. The presence of SFDs was associated with decreased treatment success (P < .001). Among different types of SFDs, the pes cavus group exhibited the lowest change in VAS and rVCSS scores before and after conservative CVD treatment. In contrast, the normal group demonstrated the highest improvement. Patients with a normal foot medial arch consistently achieved the best treatment outcomes compared with patients with other SFDs. CONCLUSIONS: In conclusion, SFDs affect outcomes of conservative treatment of CVD in CEAP 0 to 3 patients, with the efficacy of treatment dependent upon the severity of SFDs.

Novel Insights from Clinical Practice: Xia-Gibbs Syndrome with Pes Cavus, Conjunctival Melanosis, and Eye Asymmetry due to a de novo AHDC1 Gene Variant - A Case Report and a Brief Review of the Literature.

Introduction: Xia-Gibbs syndrome (OMIM 615829) is a rare developmental disorder, caused by heterozygous de novo variants in the AHDC1 gene. Hallmark features include global developmental delay, facial dysmorphisms, and behavioral problems. To date, more than 250 individuals have been diagnosed worldwide. Case Report: We report a 13-year-old female who, in association with typical features of Xia-Gibbs syndrome, presented with macrocrania, pes cavus, and conjunctival melanosis. Whole-exome sequencing identified a de novo frameshift variant, which had not been reported in the literature before. Conclusion: We summarized the main clinical and phenotypic features of patients described in the literature, and in addition, we discuss another feature found in our patient and observed in other cases described, eye asymmetry, which has never been highlighted, and suggest that it could be part of the typical clinical presentation of this condition.

Effect of sequential burr passes on minimally invasive akin and first metatarsal dorsiflexion osteotomies.

BACKGROUND: Minimally invasive surgical (MIS) osteotomies are increasing as a surgical option for treating midfoot and forefoot conditions. This study aimed to evaluate the impact of each burr pass on the degree of correction, gap size, and alignment in MIS Akin and first metatarsal dorsiflexion osteotomies (DFO). METHODS: MIS Akin and first metatarsal DFO were performed on ten cadaveric specimens. Fluoroscopic measurements included the metatarsal dorsiflexion angle (MDA), dorsal cortical length (MDCL), first phalangeal medial cortical length (PCML) and proximal to distal phalangeal articular angle (PDPAA). RESULTS: The average decrease in PCML with each burr pass was as follows: 1.53, 1.33, 1.27, 1.23 and 1.13 mm at the 1st to 5th pass, respectively. The MDCL sequentially decreased by 1.80, 1.59, 1.35, 0.75, and 0.60 mm. The MDA consistently decreased, and the PDPAA incrementally became more valgus oriented. CONCLUSION: On average, a first metatarsal dorsal wedge resection of 4.7 mm and first phalangeal medial wedge resection of 2.9 mm was achieved after 3 and 2 burr passes, respectively. This data may aid surgeons determine the optimal number of burr passes required to achieve the desired patient-specific surgical correction.

The Association of Cavovarus Foot Deformity With an Os Peroneum.

OBJECTIVE: We sought to assess whether the presence of an os peroneum is correlated with cavovarus foot alignment in patients without a neurologic explanation for their foot shape. We hypothesized that a large os peroneum would increase the power of the peroneus longus and lead to a forefoot-driven, hindfoot varus deformity. MATERIALS AND METHODS: This was a retrospective cohort study conducted at a single institution and reviewed patients with 3 weightbearing views of the foot on plain radiography. Patients were characterized into having either no os peroneum (235), a small os peroneum (18), or a large os peroneum (23). The control group included the first 101 of the 235 patients without an os peroneum based on a power analysis of the primary outcome, which was the difference in the mean Meary's angle (lateral talo-first metatarsal angle) between groups. The kite angle (anterior-posterior [AP] talocalcaneal angle), as well as 4 other angles were measured as secondary outcomes. RESULTS: Those with a large os peroneum had on a mean 7.7° (P < .01) more apex dorsal angulation of Meary's angle than controls, and a kite angle 4.2° varus to that of the control group. There were no differences between the small os peroneum and control groups. CONCLUSION: These findings add to the existing literature surrounding the etiology of cavovarus foot shape and link the presence of an ossified os peroneum, an oftentimes incidental radiographic finding, to cavovarus foot deformity in those without an underlying neurologic diagnosis. LEVELS OF EVIDENCE: Therapeutic, Level III: Retrospective Case-Control.

Understanding foot conditions, morphologies and functions in children: a current review.

This study provided a comprehensive updated review of the biological aspects of children foot morphology across different ages, sex, and weight, aiming to reveal the patterns of normal and pathological changes in children feet during growth and development. This review article comprised 25 papers in total that satisfied the screening standards. The aim was to investigate how weight changes, age and sex affect foot type, and gain a deeper understanding of the prevalent foot deformities that occur during children growth. Three different foot morphological conditions were discussed, specifically including the effect of sex and age differences, the effect of weight changes, and abnormal foot morphologies commonly documented during growth. This review found that sex, age, and weight changes would affect foot size, bony structure, foot posture, and plantar pressures during child growth. As a result of this biological nature, the children's feet generally exhibit neutral and internally rotated foot postures, which frequently lead to abnormal foot morphologies (e.g., flat foot, pronated foot, etc.). In the future, attention shall be paid to the causal factors leading to specific foot morphologies during the growth and development of children. However, sufficient evidence could not be provided due to a relatively short period of investigation and non-uniformed research methodology in the current literature. A more comprehensive and in-depth exploration is recommended to provide scientific evidence for the discovery of children foot development and personalized growth pattern.

NGS-Panel Diagnosis Developed for the Differential Diagnosis of Idiopathic Toe Walking and Its Application for the Investigation of Possible Genetic Causes for the Gait Anomaly.

Idiopathic toe walking (ITW) describes a condition affecting approximately 4.5% of children. Toe walking is an accompanying symptom for many hereditary disorders. This retrospective study uses next-generation sequencing-panel-diagnosis to investigate the feasibility of genetic testing to research the possible genetic causes of ITW and for differential diagnosis. Data were taken from our inhouse database, the minimum age for participants was 3 years. Underlying neurological or orthopaedic conditions were tested for and ruled out prior to diagnosing ITW. Patients, who experienced complications before, during or immediately after birth, children with autism, and patients toe walking less than 50% of the time were excluded. Eighty-nine patients were included in the study, in which 66 (74.2%) patients were boys and 23 (25.8%) girls. Mean age at testing was 7.7 years (range: 3-17 years). Fifteen of the 89 patients included in the study (16.9%) had a genetic variant identified as likely pathogenic or pathogenic by the genetics laboratory. Additionally, we found 129 variants of uncertain significance. About 65.2% of patients showed a pes cavus foot deformity, 27% of patients reportedly had at least one relative who also displayed the gait anomaly, and 37.1% had problems with their speech development. Despite the limitations of the sample size and the scope of our genetic testing targets, our results indicate that research into the genetic causes of ITW could better our understanding of the causes of ITW in otherwise healthy children, to help develop novel methods to detect serious conditions early. ITW could be an early onset symptom for further hereditary conditions.

The Impact of a Late Diagnosis: A Case of Charcot-Marie-Tooth Type 1.

Charcot-Marie-Tooth (CMT) is a hereditary motor and sensory neuropathy. The disease consists of a spectrum of inherited disorders caused by pathogenic variants in genes, which lead to multiple different clinical phenotypes. It is one of the most common inherited neuromuscular disorders. This disease most commonly presents with symptoms of distal weakness and muscular atrophy, which then lead to foot drop and pés cavus. In this article, we describe the case of a patient who developed muscle atrophy and distal weakness over the course of his 52 years of life, leading to gait impairment and foot deformities. Subsequent investigation led to the acknowledgment of chronic axonal sensorimotor polyneuropathy and genetic identification of the disease's genotype, CMT type 1. .

Toe Walking as the Initial Symptom of a Spinocerebellar Ataxia 13 in a Patient Presenting with a Mutation in the KCNC3 Gene.

This article at hand described a 4-year-old child patient who initially presented with the symptoms of toe walking. As part of the diagnostic process, the patient was genetically tested to find the cause of the gait anomaly. The genetic test found a mutation in the KCNC3 gene. The variant c.1268G > A; p.Arg423. His was found in a heterozygotic state. This variant is frequently described as a cause for spinocerebellar ataxia type 13 (SCA13) in the literature. Apart from toe walking as the most pronounced symptom, the patient displayed an instable gait with frequent falls and delayed speech development. The genetic test to determine the cause of the gait anomaly successfully diagnosed the patient with a previously undiscovered SCA13 and subsequently enabled the recommendation of personalized further treatment.

Forefoot Adduction, Hindfoot Varus or Pes Cavus: Risk Factors for Fifth Metatarsal Fractures and Jones Fractures? A Systematic Review and Meta-Analysis.

The origin of fractures of the fifth metatarsus and Jones fracture is not clear. The goal of this study was to investigate the evidence of anatomical deformities such as metatarsus adductus, hindfoot varus, or pes cavus as risk factors for this pathology. A literature search of records related to the review question was performed screening PubMed/Medline, Embase and Cochrane library databases (last update: May 2020) according to PRISMA guidelines. A meta-analysis was performed using the mean difference of the assessed angles (in patients with the fractures vs controls) as outcome measure to summarize literature findings about metatarsus adductus angle (MAA) indicating forefoot adduction, calcaneal pitch angle (CP) indicating hindfoot cavus and varus deformity and Talo-1st metatarsus angle/Meary's angle (T1stMA) for varus alignment. Eight studies were included in the qualitative analysis (296 patients), 5 in the quantitative synthesis (132 patients). The pooled mean difference of MAA between fracture versus control group on a per patient-based analysis was 4.62 (95% CI 1.31-7.92). Statistical heterogeneity among studies was detected (I-Square: 76.1%), likely due to different patient groups and low number of studies. The pooled mean differences of CP and T1stMA among fracture group versus controls did not show statistical significance. Despite limited literature data, metatarsus adductus deformity seems to be correlated with higher risk of proximal metatarsal fractures and Jones fracture. A significant relationship between hindfoot varus or pes cavus and these fractures was not demonstrated. Further studies and trials are warranted to shed more lights on this topic.

Technique tip: 3D printing surgical guide for pes cavus midfoot osteotomy.

BACKGROUND: Pes cavus can be defined as an abnormal elevation of the longitudinal arches, which is often secondary to a muscle imbalance. This deformity affects the foot's three dimensions (3D) and our osteotomies are usually planned on a lateral (two-dimension) X-ray. Are we really considering all the spatial components of the deformity? The aim of this study is to present a technique tip to identify the apical plane of the pes cavus deformity and perform a midfoot dorsal-based wedge resection osteotomy by using customized 3D printed surgical guides. METHODS: Three patients underwent the presented technique, all for the indication of symptomatic neuromuscular pes cavus with both anterior and posterior deformity. RESULTS: 3D-printed patient-specific guides help the surgeon to minimize human error, improving intraoperative accuracy, while reducing surgical time and intraoperative X-ray exposure. CONCLUSIONS: Closing wedge midfoot osteotomy to correct anterior pes cavus may be an interesting indication to use customized 3D printed surgical guides.

Calcaneal osteotomy for hindfoot deformity.

Calcaneal osteotomy is an extra-articular procedure used for conservative surgical treatment of hindfoot deformity. It has static, architectural and dynamic effects, reorienting the tuberosity action point of the digastric muscle formation of the sural triceps and plantar aponeurosis. Calcaneal osteotomies vary in location, form and displacement, but can be categorized as tuberosity osteotomy, acting on talar position, and cervical osteotomy, acting on Chopart joint-line orientation. We here describe the 3 main calcaneal osteotomies we use for hindfoot deformity: talar varus/valgus, valgus flatfoot, and midfoot abductus/adductus. In each case, we describe our technique, resulting from our responses to the difficulties we have had to deal with: medializing osteotomy: performed percutaneously to limit skin complications, and easily associated to cervical calcaneal osteotomy to manage valgus flatfoot; Hintermann cervical adduction osteotomy: providing excellent angular correction, while conserving a medial cortical hinge; lateralizingosteotomy: performed on a medial approach, to enhance translation capacity and prevent the acute tarsal tunnel syndrome with which we have been otherwise confronted. Correcting foot deformities involves complex, multi-dimensional, multi-tissue surgery that is risky as it concerns a segment with terminal vascularization. The present three techniques need to be mastered, as they are usually associated to other tendon and/or ligament reconstruction procedures, and tourniquet time is limited. LEVEL OF EVIDENCE: V; expert opinion.

Evaluating Acute Bilateral Foot Drop: A Case Report.

We illustrate the case of an 84-year-old Caucasian female who presented with complaints of bilateral lower extremity weakness and ambulation difficulties complicated by a unilateral deep venous thrombosis. Physical examination on hospital admission revealed an acute onset of bilateral foot drop with pes cavus deformity. Bilateral foot drop has been associated with a more chronic presentation due to metabolic, neurologic, and musculoskeletal etiologies. Acute onset of bilateral foot drop has been poorly defined in the literature and is considered a rare pathologic phenomenon, requiring additional investigation into the underlying cause of the presentation. We hypothesize that a spinal cord compression at the T12-L1 level resulted in L5 nerve root compression, resulting in our patient's presentation. Definitive treatment has not been established for this condition; however, studies have been completed to evaluate surgical versus conservative approaches to help restore patients' ambulatory function. Our aim is to incorporate this case report into the limited current literature on acute bilateral foot drop as well as outline possible treatment methods to restore impaired functionality.

Lateralizing Calcaneal Osteotomy and First Metatarsal Dorsiflexion Osteotomy for Cavovarus Foot and Peroneal Sheath Release with Peroneus Brevis Repair for Peroneal Tendinopathy in Chronic Ankle Instability and Sprain.

A 47-year-old male presented with an eight-year history of pain in the posterior inferior part of the lateral malleolus, ankle instability, and repeated right-sided ankle sprains. He had pes cavus and hind-foot varus in his right foot, which is an unknown congenital entity or acquired with tenderness in the inferior peroneal retinaculum. There is no deformity in his left foot. The pain was elicited by the movement of the subtalar joint. Imaging revealed a high medial longitudinal arch, an enlarged peroneal tubercle, thinning of the peroneus brevis tendon, and hypertrophy of the peroneus longus tendon. We diagnosed peroneal tendinopathy with cavovarus foot in a chronic ankle sprain. The supination generated by pes cavus was thought to be aggravating the peroneal tendinopathy and causing the ankle sprains. Incision of the peroneal tendon sheath, repair of the peroneus brevis tendon, lateralizing calcaneal osteotomy, and first metatarsal dorsiflexion osteotomy were performed. At the one-year follow-up, Meary's angle was corrected to 0°, the calcaneal pitch was corrected to 20°, and the hindfoot varus was improved. He was pain-free and reported no further instability when walking. His Japanese Society of Surgery of the Foot ankle-hindfoot scale score improved from 59 preoperatively to a maximum of 100 and the Self-Administered Foot Evaluation Questionnaire gave an almost perfect score for non-sports-related items and a score of 83.3 for sports-related items. We believe that the addition of treatment of the pes cavus, which was the center of the pathology, as well as treatment of the peroneal tendon, resulted in a good outcome.

Childhood onset homozygous recessive GDAP1 (p.Pro231Leu) mutation in a 9-year-old puerto rican pediatric female with axonal Charcot-Marie-Tooth disease: A case report.

Charcot-Marie-Tooth disease (CMT) is a progressive hereditary neuromuscular neuropathy with pathology in the myelin sheath or the axon. CMT caused by mutations in the Ganglioside-induced differentiation associated protein 1 (GDAP1) gene has been described by a spectrum of phenotypic presentations. GDAP1 is a mitochondrial protein responsible for protecting neuronal bodies from oxidative stress. It is associated with axonal and demyelinating pathophysiology with recessive and dominant modes of inheritance.We describe a case of a 9-year-old Puerto Rican female with clinical and electrodiagnostic results compatible with an axonal sensory-motor neuropathy where a genetic test describes a homozygous GDAP1 missense mutation at the c.692C>T (p.Pro231Leu), previously undetected in a pediatric Latino patient. Mutations in GDAP1 have been previously described in Tunisian, Old Order Amish, European and Japanese families with varying modes of inheritance. To our knowledge, this homozygous variant presentation of the GDAP1 gene is the first to be described in a pediatric Puerto Rican patient without a family history of hereditary sensory motor neuropathy.

Imaging of the Pes Cavus Deformity.

Direct-type cavus foot deformities are most commonly encountered and are primarily sagittal plane deformities. Direct deformities should be delineated from rarer triplane pes cavovarus deformities. The lateral weight-bearing radiograph is the cornerstone of imaging evaluation of direct pes cavus foot deformity. The apex of Meary talo-first metatarsal angle on the lateral radiograph represents the pinnacle of the cavus deformity and assists in subclassification of the deformity. With routine application, ancillary radiographic imaging techniques, such as the modified Saltzman view or the modified Coleman block test, can give valuable insight into deformity assessment and surgical planning.

Use of Calcaneal Osteotomies in the Correction of Inframalleolar Cavovarus Deformity.

Cavovarus deformity is a complicated condition most commonly resulting from neurologic, posttraumatic, or iatrogenic pathologic conditions. Careful evaluation of the cavovarus patient is necessary in determining appropriate treatment course. Weight-bearing radiographs are necessary, and advances in computed tomographic technology can be beneficial in identifying level of involvement. In the case of operative treatment of inframalleolar deformity, assessment of the subtalar joint position and relation of calcaneocuboid joint can be of assistance. Multiple osteotomies have been described providing uniplanar, biplanar, and triplanar correction and in the appropriate setting can prove beneficial to the surgeon in treating hind-foot cavovarus deformity.

Management of Midfoot Cavus.

There is a deficiency in publications on the topic of midfoot cavus. The limited research available does not have a standard definition for the diagnosis of this deformity and lacks a reliable algorithm for its surgical management. The authors performed an extensive review of the literature that found a majority of patients are satisfied with the Cole osteotomy and the dorsiflexory first metatarsal osteotomy for treatment of this condition. High patient satisfaction has been observed with lateralizing calcaneal osteotomies in the setting of midfoot cavus with a secondary rigid rearfoot deformity. Further research on this topic is encouraged.

Tendon Transfers and Their Role in Cavus Foot Deformity.

Management of the cavus foot is a difficult task for the foot and ankle surgeon. Tendon transfers have been a longstanding accepted treatment for the flexible cavus foot. Performing tendon transfers requires an in-depth understanding of the patient's medical history, factors leading to the development of deformity, as well as the deforming forces contributing to the deformity. Evaluation of the patient for rigid, progressive, and/or spastic deformities is critical to avoid postoperative complications. Educating the patient on postoperative rehabilitation, potential complications, and postoperative expectations is essential to ensure appropriate surgical outcomes.

Paediatric flat foot and foot dimension in Central Anatolia.

BACKGROUND: Information on the foot structures of Central Anatolian children is limited. Foot structures of children aged 6-10 years were shown to be different according to sex and increasing age. OBJECTIVE: This study aimed to compare the foot anthropometric values by age and sex and collect the foot anthropometric data to reveal the relationship between pes planus and pes cavus in the arches of children according to age. METHODS: Footprints of 335 children (180 boys and 155 girls) aged 6-10 years were taken by the pedigraph method and evaluated using 18 different parameters. The TFL (Truncated foot length), FL (foot length), Arch Index, Chippaux Smirak Index, Staheli Arc Index, and foot rotation values of the children were examined. To examine the relationship between the parameters, normality values were examined. Independent samples t-test was used to analyze sex differences in terms of foot size and shape. RESULTS: Correlations between other parameters were determined using the correlations analysis method. TFL, metatarsal circumference, and FL were strongly correlated with age in the children. Foot rotation increased with body mass index in the girls compared to that in the boys. According to the evaluation results with the classification made with the Staheli arch index, 63.3% pes planus, 9.8% pes cavus and 27.7% of the normal arch structure were identified. CONCLUSIONS: Planning shoe production accordingly will contribute to the development of healthy feet in children. This article focused on foot structures of in Central Anatolia and to identify early foot deformities in children. This study found that the length of the TFL was smaller in boys than in girls.